title: Selecting patients with locally advanced rectal cancer for neoadjuvant treatment strategies.
abstract: Rectal cancer remains a significant problem worldwide. Outcomes vary significantly according to the stage of disease and prognostic factors, including the distance of the tumor from the circumferential resection margin. Accurate staging, including high-resolution magnetic resonance imaging, allows stratification of patients into low-, moderate-, and high-risk disease; this information can be used to inform multidisciplinary team decisions regarding the role of neoadjuvant therapy. Both neoadjuvant short-course radiotherapy and long-course chemoradiation reduce the risk of local recurrence compared with surgery alone, but they have little impact on survival. Although there remains a need to reduce overtreatment of those patients at moderate risk, evaluation of intensified regimens for those with high-risk disease is still required to reduce distant failure rates and improve survival in these patients with an otherwise poor prognosis.
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London and Surrey, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Dewdney
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome
keywords: Chemoradiation; Magnetic resonance imaging; Neoadjuvant treatment; Rectal cancer